Assembly for fixing a tube for medical purposes to a patient&#39;s mouth

ABSTRACT

The invention relates to an assembly for fixing a tube for medical purposes to a patient&#39;s mouth, the tube being fixed to the patient&#39;s head. According to the invention the assembly comprises a tube clamping means which can be attached to the tube in a detachable manner, which tube clamping means is provided with positioning means connected thereto, which position the tube clamping means during use with the help of flexible, detachable securing means that arc to be arranged around the patient&#39;s head, the tube clamping means being designed such that it can be clamped around the tube after arranging the tube in the patient&#39;s mouth without disturbing the location of the tube.

The invention relates to an assembly for fixing a tube for medicalpurposes to a patient's mouth, the tube being fixed to the patient'shead.

When anaesthetizing a patient an endotracheal tube or respiration tubehas to be inserted in the patient's windpipe or a larynx mask has to beinserted in the patient's throat. After intubation the annular spacebetween the tube and the windpipe has to be closed off so that thepatient breathes only through the tube. This closing off is effectedwith a balloon, which is inflated after insertion. In order that thetube with the balloon is not moved in the windpipe, which could lead todamage of the windpipe, the tube has to be fixed to the patient's head.

Usually the tube is fixed with the help of a band aid and/or a ribbon.This, however, has the disadvantage that a band aid no longer adhereswell when it becomes moist, and that when removing the band aid the skincould get damaged. When using a ribbon it has to be tied tightly aroundthe neck, which results in pressure on the underlying structures and thepossibility that the skin among others near the corners of the mouth canget cut in. A further disadvantage is that the band aid or the ribboncannot be removed quickly. Danger of contamination is another drawback.

In U.S. Pat. No. 4,249,529 a tube clamp is shown, which with the help oftwo cords can be secured to the patient's head. The tube clamp comprisestwo semi-circular clamping members, which are attached to a plate viaarms that are inclined towards each other and which are connected toeach other by means of a hinge. The tube is clamped by pressing bothclamping members in a direction opposite to the coinciding component ofthe arms, as a result of which the clamping members hinge towards eachother into a closing position. This activity is rather difficult tocontrol, as a result of which a longitudinal displacement of the tubeduring the process of letting it clamp is possible here. Also the trackover which the tube has to be moved in transverse direction issubstantial, because of which the danger of displacement only increases.The result may be that the tube, of which the anaesthetist had firstnoticed that its end was correctly situated near the fork of the lungs,moves to such an extent that it extends in one of the lungs with oneend. The other lung is then sidetracked, which entails major risks forthe patient during the operation. Moreover, the efficiency of theballoon closing may be insufficient.

From the literature several other devices are known to fix anendotracheal tube to the patient's head. None of these knownconstructions, however, offers a satisfactory solution in practice. Inparticular the ease of placing and quick removal of the device are notachieved.

It is an object of the invention to provide an assembly for fixing atube for medical purposes in a patient's mouth, which can easily andreliably be placed by the anaesthetist. It is another object of theinvention to provide an assembly which can quickly be removed from thetube. It is yet another object to provide an assembly which can partlybe arranged on the patient's head in advance. It is a further object ofthe invention to provide an assembly which after being used once can bedisposed of. It is yet a further object of the invention to provide anassembly which can be made in a simple and cheap manner. These andfurther objects appear from the description below.

One or more of these objects are achieved with an assembly for fixing atube for medical purposes to a patient's mouth, the tube being fixed tothe patient's head, comprising a tube clamping means which can beattached to the tube in a detachable manner, which tube clamping meansis provided with first positioning means, further comprising flexible,detachable securing means that are to be arranged around the patient'shead and are provided with second positioning means that can beconnected to the first positioning means, to position the tube clampingmeans during use, the tube clamping means comprising a first tubeclamping member, which is solid with the first positioning means, and asecond tube clamping member, which is hingeable with respect to thefirst tube clamping member for movement between an open position, inwhich the tube clamping means can freely receive the tube, and a closedclamping position, in which the tube is kept clamped with respect to thetube clamping means and the first positioning means.

The tube clamping means need not be arranged until after the patient hasbeen intubated. With the help of detachable securing means and thesecond positioning means the tube clamping means can be positioned bymeans of the first positioning means, the first clamping member solidtherewith stabilizing the tube to be clamped during clamping. Theanaesthetist can focus his attention to rotating the single otherclamping member. In this manner unwanted tube displacements which may bedamaging to the patient, can be prevented.

Preferably the first tube clamping member is arranged in order to extendunder the tube during use, so that this clamping member constitutes asit were a bearing for the tube that is not (entirely) clamped yet.

Preferably the two tube clamping members are formed by two half ovalrings, which along one edge are connected to each other by means of ahinge, preferably a living hinge. It is furthermore preferred when thefirst and the second tube clamping members are hingeable about an axiswhich is substantially parallel to the tube to be clamped.

Preferably the two tube clamping members are securable to each other intheir clamping position by means of catching means, preferablycomprising a snap finger at the one clamping member and a cam at theother clamping member, the snap finger then being detachably snappablebehind the cam. In this way the tube clamping means can be closed andopened in an easy and therefore controllable manner.

In the unlikely event of a tube being used that does not exactly fit,fixation against axial displacement of the tube is improved when bothtube clamping members are provided at their insides with a number ofinwardly directed tube fixation protrusions. With the help of thesefixation protrusions the clamped tube is held additionally and cannot bepulled through the tube fixation means.

Preferably one of the tube clamping means is provided with a recess forletting through a pilot tube (for supply and discharge of air to andfrom the balloon sleeve) on the tube, so that the pilot tube cannot beclamped off. It is preferred here when the first tube clamping member isprovided with a continuous recess, which extends, at least at the outerend of the clamping member, over its entire wall cross-section. It isprevented in this way that with a curved tube the pilot tube is pressedclosed as yet at the outer end of the clamping member. This is of vitalimportance. When the balloon sleeve is insufficiently inflated namely, apart of the stomach contents may end up in the lung. On the other hand,when the sleeve remains inflated to hard, tissue damage resulting inscars may occur.

According to an advantageous embodiment the tube clamping member isentirely made from synthetic, preferably from polypropene. As a resultthe tube clamping means can easily and cheaply be manufactured byinjection moulding, as a result of which it can be used as a disposableproduct. Also the material is well adjusted to the human body. Theclamping members in themselves are relatively rigid.

Preferably the hinge is a living hinge, so that the hinge can be madeduring injection moulding without additional measures being necessary.In this way the tube clamping means remains cheap.

Preferably the first positioning means are provided on a plate which issubstantially transverse to the tube clamping means, which platepreferably is provided with a slot to let the tube through whenarranging the plate, the plate preferably being substantially U-shaped.With the help of the plate the tube clamping means can easily be placedat the patient's head, whereas the plate further provides good supportagainst the patient's head.

Preferably the first positioning means comprise-preferablyvertical-slots, for letting through attachment straps belonging to thesecond positioning means. For optimal transfer of forces thus four slotscan be arranged in the plate, mainly at the vertices of a rectangle.

According to a preferred embodiment the plate is adapted to the anatomyof the patient's face, so that the pressure on the patient's face cannever become to high.

Preferably a bite member for between the patient's teeth is provided atthe rear of the plate. Because of this bite member the patient will notaccidentally be able to bite in the tube, as a result of which thepassage opening becomes too small and the tube could get damaged.

Preferably the bite member is substantially U-shaped in cross-section toallow the tube through. The U-shaped bite member connects to theU-shaped plate, so that the whole can be slid around the tuba from thechin side after which the tube clamping means can be clamped around thetube. After detaching the tube clamping means the plate with the bitemember can easily be removed again.

Preferably the bite member and the plate are provided with concavesurfaces and edges, respectively, at their sides, so that as much roomas possible is left to get into the mouth, for instance with medicalinstruments.

Preferably the plate and the bite member are provided with recessesaligned with the aforementioned recess for allowing through a pilot tubeon the tube. The recess in the bite member can be continuous over theentire length and its wall cross-section, so that the pilot tube hasample possibilities to extend into the mouth in an unclamped manner.

According to a further development the second positioning means comprisean occipital strap and a number of flexible, detachable attachmentstraps extending between the occipital strap and the first positioningmeans. With the-flat-strap around the head and the-flat-adjustablestraps the plate with the tube clamping means can be positioned and keptin place well, with a correctly adjustable tightness of the strapsaround the head. The straps are soft and do not adhere to the user'shead, so that the skin will not be damaged or cut in.

Preferably the straps that are adjustable as to length run through therecesses in the plate and they can be secured on themselves. The strapsadjustable as to length are thus attached to the plate and do not needto be separately arranged.

According to another preferred embodiment the straps adjustable as tolength are accommodated to the plate when said plate is manufactured.For instance when injection moulding the plate the ends of the strapscan be laid in the matrix, after which the plate is formed around theends.

Preferably the straps adjustable as to length can be adjustable as tolength by means of Velcro.

Preferably each strap that is adjustable as to length is connected tothe plate on two locations and has a recess in between them. As a resultof the connection on two locations on both sides the plate can bepositioned in a very stable manner, and because of the recesses in thestraps the inside of the mouth can still be reached along the plate.

The occipital strap in an advantageous manner is provided at both endswith a recess to let through the ends of the attachment straps that areadjustable as to length, the occipital strap-in order to have the strapsabut tightly and in a flat manner-preferably being provided with meansfor stiffening the recesses, such as a little rod extending along therecess, said rod preferably being situated at the side of the recessfacing the attachment strap. In this way the occipital strap remainstight there and the forces are transferred better. Quickly untying incase of an emergency is also improved.

For an optimal transfer of forces the recesses are situated at the levelof is the corners of the jaw. The forces are then transferred, at leastfor the larger part, on the jaw corner and deflected upwards for a smallpart, via the temple. This is much more comfortable for the patient andbetter for the blood circulation, because there is no pressure on theblood vessels below and adjacent to the jaw. In addition these areas arethen free for insertion of monitor lines, such as for instance in theneck.

Preferably the occipital strap is accommodated in a hat or cap to beplaced over the patient's head. In this way the occipital strap isimmediately in the correct place after arranging the cap or hat, and thestrap cannot be displaced during use. The cap does not only give easeand certainty of placement, it also performs a function in counteractingthe loss of warmth through evaporation and radiation. Usually the lossof warmth via the head is about 20-30%. The cap thus provides a passivemeans for keeping the body at the right temperature.

Preferably the strap also runs along the lower side of the patient'sears during use.

Preferably the hat is provided with recesses for the patient's ears, sothat ear operations and the like can be performed. Moreover the bloodsaturation of the ears is ensured. The position of the ears can also bechecked, which is of importance when the patient is lying with his earon a pillow. One is then able to see from aside whether the ear is inthe correct position. This is of importance, because the ears are endorgans and may die off in a situation in which they are pinched off.Another advantage is that measuring can now still be performed on theear, for instance a pulsoxy meter, for assessing the blood circulation.

The cap can be arranged in advance. The attachments for the mouthpieceare situated on the side, so that without moving the patient's head themouthpiece can be attached with the help of the Velcro strips.

The cap can furthermore fulfill another function, when it extends overthe head and at the front/upper side is provided with means forattachment of either care or monitor lines. The cap thus also providessurfaces available for securing catheters/probes and other lines. Inthis manner a drip line can be arranged in the neck, said line beingattached on the side of the cap. Stomach and temperature probes can belaid over the head towards the nose, and be secured on top of the capwith the help of the Velcro strips.

The invention furthermore relates to a tube clamping means suitable forthe assembly of the invention, as well as to the above-mentioned hat orcap.

The invention will be elucidated on the basis of an exemplaryembodiment, referring to the attached drawing.

FIG. 1 schematically shows a patient, the assembly according to theinvention being used and the assembly comprising schematically showntube clamping means, positioning means and attachment means.

FIG. 2 shows the tube clamping means according to the invention inperspective view.

FIG. 3 shows the tube clamping means according to FIG. 2 in front view.

FIG. 1 schematically shows the patient's head 1, a respiration tube 10being inserted in the windpipe through the patient's mouth. Around thepatient's head 1 an assembly 20 is arranged for fixing the respirationtube 10. The assembly 20 consists of a tube clamp 30, a positioningplate 40, two attachment straps 50, and a pulling strap 61 which isaccommodated in a cap 60.

The tube clamp 30 and the positioning plate 40 are shown in more detailin FIGS. 2 and 3.

FIG. 2 shows the tube clamp 30 and the positioning plate 40 inperspective view. The tube clamp 30 consists if a moveable half ovalring 31 which can be moved with respect to a half oval ring 32 which issolid with the plate 40, in which both half oval rings are connected toeach other by means of a living hinge 33. The movable half oval ring 31has a snap finger 34, which can hook about a cam 35 on the solid halfoval ring 32. The snap finger 34 is elastic in order to remove the snapfinger 34 from the cam 35, so that the half oval ring 31 can be openedwith respect to the half oval ring 32. Both half oval rings 31 and 32are of such a size that they can clamp the respiration tube 10 betweenthem in the closed position of the tube clamp 30. The inside of themember 31 is provided with a fixation protrusion 36, and the inside ofthe solid member 32 is provided with two fixation protrusions toadditionally fix the respiration tube 30 in longitudinal direction, inaddition to the frictional forces. The solid half oval ring 32 isprovided with a recess 37 extending transverse through the wall in orderto accommodate a pilot tube (see 73, FIG. 1), which runs along therespiration tube 10, for a large part loose at the concave bentlowerside thereof, without pressing the pilot tube closed.

The positioning plate 40 consists of a plate member 41 of asubstantially rectangular shape, four vertical slots 42 being arrangedin the corners, for the attachment of the attachment straps 50 (see FIG.1). The plate member 41 is provided with a U-shaped slot 43 to let therespiration tube 10 through to the tube clamp 30 and is provided withrecesses 44 on both sides, so that the plate member 41 leaves sufficientspace around the respiration tube 10 after arrangement to get into thepatient's mouth with for instance medical instruments. At the rear ofthe plate member 41 a bite member 45 is arranged which is formed as oneunity therewith, which bite member is in line with the half oval ring 32and which is provided with a U-shaped recess in order to accommodate therespiration tube 10, so that the tube 10 cannot be squeezed together bythe patient's teeth. The bite member 45 is provided with recesses at thesides which connect to the recesses 44 in the plate member 41.

As can be seen in FIGS. 2 and 3 the recess 37 is continued in the platemember 41 and the bite member 45, the recess 37 also extending throughthe entire wall thickness in the bite member.

FIG. 3 shows the parts of the tube clamp 30 and the positioning plate 40in front view.

The tube clamp 30, the positioning plate 40 and the bite member 45 aremanufactured as one unity from a suitable synthetic, such aspolypropene. The mouthpiece, consisting of the tube clamp 30, thepositioning plate 40 and the bite member 45 can then be made by means ofinjection moulding.

Polypropene here has the advantage that it can be made transparent, sothat the information on the respiration tube 10 can still be read.

The attachment straps 50 have two fingers 51 at one end, which areseparated by a recess 52. The attachment straps 50 are made from aflexible, soft material such as Medifoam®, and the fingers 51 are pulledthrough the slots 52 in the positioning plate 41 and turned and securedon themselves, for instance by sewing. Because of the recesses 52 it ispossible to get into the patient's mouth for instance with medicalinstruments. The other end of the attachment straps 50 is provided withVelcro, the last part 43 for instance being provided with looped tape,and the part preceding it being provided with barbed tape.

The assembly further consists of a cap 60, which fits rather closely tothe patient's head 1, and which leave the patient's ears free. At thelower edge of the cap 60 an occipital strap or pulling strap 61 isaccommodated in the cap 60, which pulling strap 61 can run underneaththe patient's ears behind the patient's head and which pulling strap 61is provided with a slot 62 at its ends where the part 53 of theattachment strap 50 can be inserted through. At the front side of theslot 62 a little rod is accommodated in the material of the cap 60, inorder to maintain the shape of the slot 62 and to distribute the forcesbetter.

The use of the assembly is as follows.

The hat can already be placed on the patient's head during thepreparations of the operation. Subsequently the respiration tube 10 isarranged in the patient's windpipe. When said respiration tube 10 ispositioned correctly, the positioning plate 40 is slid around the tube10, the U-shaped recess 43 moving around the tube 10, until the tube 10lies in the half oval ring 32. The pilot tube 73 then extends downwardsthrough the recess 37 free from the tube. The bite member 45 is placedbetween the patient's teeth. The ends 53 of the attachment straps 50 areinserted through the slots 62 in the pulling strap 61, and the ends 53are pulled such and folded down to such an extent that the pulling strap61 is brought at the right tension. Subsequently the strap portion 53with looped tape is attached on the strap portion 54 with barbed tape.The positioning plate 40 is fixed on the patient's head in that way.Finally the respiration tube 10, after the anaesthetist has ascertainedthat its end is situated in the correct location, is fixed in the tubeclamp 30 by rotating the half oval ring 31 to the solid half oval ring32 and then to secure it with the snap finger 34 about the cam 35.

The advantage of fixing in this order is that the movements of therespiration tube 10 can be kept limited to a minimum in this way.

The advantage of the cap 60 is that from a hygienic point of view itretains the hair, and ensures that the pulling strap 61 cannot slidedown from the jaw corner to the neck. Furthermore cooling down of thehead is counteracted. It is further expected that a patient will haveless objections to a cap than to just wearing a pulling strap. The cap60 can furthermore be useful in securing care lines, such as the stomachcatheter 72, which with the help of Velcro 71 cooperating with theVelcro surface 70 on the cap 60 can be secured (see FIG. 1).

The assembly is easy to detach by operating the snap finger 34 andpulling the Velcro loose from the portion 53. In case of an emergencythe respiration tube 10 can be detached from the patient with themouthpiece still on it, just by untying the Velcro on both sides.

1. An assembly for fixing a tube to a patient's mouth for medicalpurposes, the assembly comprising tube clamping means for detachablyclamping the tube with the tube fixed to the patient's head, the tubeclamping means comprising (a) first positioning means for positioningthe tube, (b) a first tube clamping member, (c) a second tube clampingmember; and (d) means for hingeable movement of the second tube clampingmember with respect to the first tube clamping member wherein said firstpositioning means has a top portion that extends above a top portion ofthe first and second tube clamping members and a bottom portion thatextends below a bottom portion of the first and second tube clampingmembers, said first tube clamping member being fixedly disposed withrespect to the first positioning means and having a concave bearingsurface which curves toward the top portion of the first positioningmeans, and wherein the second tube clamping member is moveable between aclosed clamping position, in which the tube is kept clamped between thefirst and second tube clamping members with the first tube clampingmember extending under the tube, and an open position, in which the tubeclamping means can freely receive the tube and the tube can find supporton the concave bearing surface of the first tube clamping member,without movement of the first tube clamping member relative to the firstpositioning means, the assembly further comprising securing means fordetachably securing the assembly around the patient's head, saidsecuring means comprising second positioning means for connecting thesecuring means to the first positioning means to facilitate positioningof the tube clamping means.
 2. The assembly according to claim 1,wherein the first positioning means comprises a positioning plate whichis substantially transverse to the first and second tube clampingmembers and is integrally formed with the first clamping member.
 3. Theassembly according to claim 2, wherein the positioning plate comprises aslot for the tube.
 4. The assembly according to claim 3, wherein thepositioning plate is substantially U-shape.
 5. The assembly according toclaim 2, wherein the first positioning means comprises a plurality ofslots for attachment straps of the second positioning means, four of theslots being disposed in the plate in a rectangular configuration.
 6. Theassembly according to claim 2, wherein the positioning plate is adaptedto conform to the patient's face.
 7. The assembly according to claim 2,wherein the positioning plate comprises a bite member at a rear portionthereof for positioning between teeth of the patient.
 8. The assemblyaccording to claim 7, wherein the first tube clamping member comprises acontinuous recess that, at least at an outer end of the first tubeclamping member, extends over an entire cross-section of the first tubeclamping member, whereby to accommodate a pilot tube, the positioningplate and the bite member comprising recesses that are aligned with thecontinuous recess for the pilot tube, the recess in the bite memberbeing continuous over an entire length and cross-section of the bitemember.
 9. The assembly according to claim 7, wherein the bite member issubstantially U-shape in cross-section.
 10. The assembly according toclaim 7, wherein the bite member and the positioning plate compriserespective concave surfaces and edges at sides thereof.
 11. The assemblyaccording to claim 1, wherein the second positioning means comprises anoccipital strap and a plurality of flexible, detachable attachmentstraps that extend between the occipital strap and the first positioningmeans, the occipital strap comprising slots for the attachment straps,the second positioning means comprising means for adjusting theattachment straps as to length whereby the attachment straps can besecured to themselves on both sides of the patient's head with the suchthat, after the tube is clamped between the first and second tubeclamping members, the tube can be fixed to the patient's head.
 12. Theassembly according to claim 11, wherein the first positioning meanscomprises a positioning plate which is substantially transverse to thefirst and tube clamping members and which is integrally formed with thefirst tube clamping member, the attachment straps being connected to thepositioning plate.
 13. The assembly according to claim 11, wherein themeans for adjusting the attachment straps as to length comprises velcro.14. The assembly according to claim 11, wherein each of the attachmentstraps is connected to the plate at a plurality of locations and has arecess between the plurality of locations.
 15. The assembly according toclaim 11, wherein the occipital strap comprises means for stiffening theslots.
 16. The assembly according to claim 15, wherein the means forstiffening comprises a rod extending along a side of the slot.
 17. Theassembly according to claim 11, wherein the slots are adapted to bedisposed at a level with corners of a jaw of the patient with theassembly adapted to fix the tube to the patient's mouth.
 18. Theassembly according to claim 11, wherein the occipital strap isaccommodated in a cap for placement over the patient's head.
 19. Theassembly according to claim 18, wherein the cap comprises recesses forthe patient's ears.
 20. The assembly according to claim 18, wherein thecap is adapted to extend over the patient's head with the assemblyadapted to fix the tube to the patient's mouth, the cap comprising meansfor attachment of care or monitor lines at a front or upper sidethereof.
 21. The assembly according to claim 1, wherein the means forhingeable movement provides for hingeable movement of the second tubeclamping member about an axis that is substantially parallel to the tubewhen the tube is received in the tube clamping means.
 22. The assemblyaccording to claim 21, wherein each of the first and second tubeclamping members comprises a half oval ring, the means for hingeablemovement comprising a hinge, the half oval ring of each of the first andsecond tube clamping members being connected to each other by the hinge.23. The assembly according to claim 1, comprising catching means forsecuring the first and second tube clamping members to each other withthe second tube clamping member in the closed clamping position.
 24. Theassembly according to claim 23, wherein the first and second tubeclamping members collectively comprise snap finger and cam means fordetachably snapping the second tube clamping member to the first tubeclamping member with the first and second tube clamping members in theclosed clamping position.
 25. The assembly according to claim 1, whereineach of the first and second tube clamping members comprises aprotrusion that protrudes inwardly for fixing the tube.
 26. The assemblyaccording to claim 1, wherein the first positioning means comprises aplurality of slots for attachment straps of the second positioningmeans.
 27. The assembly according to claim 26, wherein the slots arealigned.
 28. The assembly according to claim 1, wherein the first tubeclamping member comprises a continuous recess that, at least at an outerend of the first tube clamping member, extends over an entirecross-section of the first tube clamping member, whereby to accommodatea pilot tube.
 29. The assembly according to claim 1, wherein the tubeclamping means comprises a synthetic material.
 30. The assemblyaccording to claim 1, wherein said first tube clamping member isintegrally formed with the first positioning means whereby it maintainsits position with respect to the first positioning means during movementof the second tube clamping member between said open and closedpositions.
 31. The assembly according to claim 1, wherein the secondpositioning means comprises an occipital strap which is accommodated ina cap for placement over the patient's head.
 32. The assembly accordingto claim 1, wherein the first positioning means has top a portion thatextends above the first and second tube clamping members, the topportion comprising first and second parts defining an opening disposedabove the concave bearing surface and extending throughout the topportion whereby a tube can be inserted from above the top portionbetween the first and second parts and onto the concave bearing surface.33. The assembly according to claim 1, wherein said assembly comprises abite member having a concave bearing surface that is conterminous withthe concave bearing surface of the first tube clamping member, with thesecond tube clamping member covering only the concave bearing surface ofthe first tube clamping member in the closed clamping position.
 34. Amethod for fixing a tube to the mouth of a patient comprising the stepsof: (i) providing the assembly of claim 1; (ii) clamping the tube in thetube clamping means, with the securing means secured to the patientshead and with the tube fixed to the patient's head, by moving the secondtube clamping member between the open position and the closed clampingposition with the first tube clamping member fixed to the first positionmeans; wherein the top portion of the first positioning means extendsabove a top portion of the first and second tube clamping members andabove lips of the patient and a bottom portion of the first positioningmeans extends below the first and second tube clamping members and belowthe lips of the patient.
 35. An assembly for fixing a tube to apatient's mouth for medical purposes, the assembly comprising tubeclamping means for detachably clamping the tube with the tube fixed tothe patient's head, the tube clamping means comprising (a) firstpositioning means for positioning the tube, (b) a first tube clampingmember, (c) a second tube clamping member; and (d) means for hingeablemovement of the second tube clamping member with respect to the firsttube clamping member, wherein said first positioning means has a portionthat extends above the first and second tube clamping members, and aportion that extends below the first and second tube clamping members,when the tube is fixed to the patient's mouth, and the second tubeclamping member is moveable between a closed clamping position, in whichthe tube is kept clamped between the first and second tube clampingmembers with the first tube clamping member extending under the tube,and an open position, in which the tube clamping means can freelyreceive the tube and the tube can be supported on the first tubeclamping member, which provides an upwardly facing bearing surface forthe tube, without movement of the first tube clamping member relative tothe first positioning means, the assembly further comprising securingmeans for detachably securing the assembly around the patient's head,said securing means comprising second positioning means for connectingthe securing means to the first positioning means to facilitatepositioning of the tube clamping means.
 36. The assembly according toclaim 35, wherein the second positioning means extends above and belowsaid tube.
 37. The assembly according to claim 36, wherein said secondpositioning means comprises an upper second positioning means thatextends above said tube, and a lower second positioning means thatextends below said tube.
 38. An assembly for fixing a tube to the mouthof a patient for medical purposes, the assembly comprising tube clampingmeans for detachably clamping the tube to fix to the patient's head, thetube clamping means comprising (a) first positioning means forpositioning the tube, (b) a first tube clamping member, (c) a secondtube clamping member; and (d) means for hingeable movement of the secondtube clamping member with respect to the first tube clamping member,said first tube clamping member being fixedly disposed with respect tothe first positioning means, and said second tube clamping member beingmoveable between a closed clamping position, in which the tube is keptclamped between the first and second tube clamping members with thefirst tube clamping member extending under the tube, and an openposition, in which the tube clamping means can freely receive the tubeand the tube can find support on the first tube clamping member, theassembly further comprising securing means for detachably securing theassembly around the patient's head, said securing means comprisingsecond positioning means for connecting the securing means to the firstpositioning means to facilitate positioning of the tube clamping means,wherein the second positioning means comprises an occipital strap,wherein the occipital strap is accommodated in a cap for placement overthe patient's head.
 39. The assembly according to claim 38, wherein thecap comprises recesses for the patient's ears.
 40. The assemblyaccording to claim 38, wherein the cap is adapted to extend over thepatient's head and the assembly is adapted to fix the tube to thepatient's mouth, the cap comprising means for attachment of care ormonitor lines at a front or upper side thereof.
 41. The assemblyaccording to claim 38, wherein the second positioning means comprises aplurality of flexible, detachable attachment straps that extend betweenthe occipital strap and the first positioning means, the occipital strapcomprising slots for the attachment straps, the second positioning meanscomprising means for adjusting the attachment straps as to lengthwhereby the attachment straps can be secured to themselves on both sidesof the patient's head.
 42. The assembly according to claim 41, whereinthe means for adjusting as to length comprises velcro.
 43. The assemblyaccording to claim 41, wherein each of the attachment straps isconnected to the plate at a plurality of locations and has a recessbetween the plurality of location.
 44. The assembly according to claim41, wherein the occipital strap comprises means for stiffening theslots.
 45. The assembly according to claim 44, wherein the means forstiffening comprises a rod extending along a side of the slot.
 46. Theassembly according to claim 41, wherein the slots are adapted to bedisposed at a level with corners of a jaw of the patient with theassembly adapted to fix the to the patient's mouth.